Workers' Compensation Defense
An employer does not, merely by retaining a worker or employee, guarantee to compensate that person for any wage loss or medical expense incurred as a result of a work-related injury. Instead, a handful of defenses are available to the employer in some cases. The success of any particular defense will depend greatly on the laws of the particular state, the nature of the employer-employee relationship, and the facts and circumstances of the injury in question.
A basic defense that the employer may assert is the fact that the injured individual was not an employee and, hence, not entitled to workers' compensation benefits. The very purpose of workers' compensation is to protect and provide for injured employees. Individuals who are not employees are not entitled to workers' compensation benefits. A typical definition of an employee is a person who works for another, under the other's control, for hire. Thus, an independent contractor is distinguishable from an employee; the employee is entitled to workers' compensation benefits, the contractor is not. Similarly, volunteers are not entitled to workers' compensation benefits in most cases. In addition, state statutes may exclude from the category of covered employees those whose work is both casual and not in the usual course of the employer's business, unless an employer elects to include them. The determination of whether a particular individual is a casual employee is very fact specific.
Many state statutes specifically exclude agricultural workers and members of family farm enterprises from workers' compensation coverage, while minors who are injured in the course of employment are afforded coverage. Again, a determination of whether workers' compensation benefits are appropriate in these areas is extremely fact specific and depends on the individual state statute. In rather rare circumstances, an employer may defeat a claim for compensation in some jurisdictions by arguing that the loaned-servant doctrine applies. In short, the doctrine assumes that an individual who is the employee of a "general" employer, who then "loans" the employee to a "special" employer, may not actually be an employee of both employers for purposes of workers' compensation recovery. The adage "a man cannot serve two masters" is the key behind the loaned-servant doctrine, and the purpose of the doctrine is to delineate which employer, if either, is responsible for providing workers' compensation coverage to the injured employee. In some jurisdictions, the statute will dictate when, and whether, an employee may recover benefits under a loaned-servant situation. Other states rely upon prior case law to interpret whether the general employer, the special employer, or in some cases, both, are responsible for providing workers' compensation coverage to the employee.
In addition to questioning the status of the individual as an employee, an employer may also defend a claim based on the specific manner in which the injury occurred or is alleged to have occurred. Generally, an injury must fall within the catch phrase "arising out of the course and scope of employment" in order to allow for workers' compensation benefits. For example, in most states, when the injury results from an assault, coverage is not afforded, because such injuries generally do not "arise out of" employment, unless the nature of the employment is related to the likelihood of the assault occurring, such as may be the case for police officers. In some states, even where the assault has been prompted by personal feelings of ill will by the offender toward the injured individual, benefits may be available if the nature of the work has somehow contributed to the occurrence of the assault.
Where an injury occurs as a result of horseplay in the workplace, and the party injured is the instigator of the horseplay, a claim for workers' compensation benefits may be defeated as not arising out of the employment. An injury occurring during the commission of a serious crime will often not be compensable. Similarly, an employer may defeat a claim for workers' compensation benefits if it is shown that the alleged injury or condition was the sole result of a pre-existing injury or condition not related to the employment. However, where a pre-existing condition is aggravated or exacerbated by the employment, then coverage may be afforded as it is deemed to be an injury "arising out of" the employment.
An employer may also defeat a claim by arguing that an injury did not occur in the "course and scope" of the employment. For example, most states have a coming-and-going rule that holds that injuries that occur while an employee is traveling to and from work are not compensable unless they occur on the employer's premises. Exceptions that may allow compensation include situations in which the employer has provided transportation to the employee, where travel time is a compensated portion of the employee's workday, or where the nature of the employer's business necessitates the travel.
Similarly, employee intoxication and/or an employee's willful misconduct may bar receipt of benefits. These defenses are rather narrow and require strict proof. In some jurisdictions, for example, recovery may be denied only if the employee's intoxication was the sole cause of the injury.
Finally, in some jurisdictions an employee's dependents may be denied workers' compensation dependency benefits if the employee committed suicide. A minority of jurisdictions hold that recovery is allowed only in those cases in which there is concrete proof that the worker suffered from a mental disorder of such degree as to deprive the worker of any exercise of volition. In the majority of jurisdictions, compensation may be permitted if it is shown that an unbroken chain of causation stretches between a work-related injury and a mental condition, which in turn leads to the suicidal act.
Additional defenses to a workers' compensation claim may be available to an employer in some states. The availability of these defenses, and the potential for success, depends on the jurisdiction and the facts of the particular case.
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